Healthcare Provider Details

I. General information

NPI: 1639991581
Provider Name (Legal Business Name): COUNTY OF SONOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 CAPRICORN WAY, SUITES 207, 211, 213
SANTA ROSA CA
95407
US

IV. Provider business mailing address

2227 CAPRICORN WAY, SUITES 207, 211, 213
SANTA ROSA CA
95407
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4810
  • Fax:
Mailing address:
  • Phone: 707-565-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SEAN BARKER
Title or Position: RMU MANAGER
Credential:
Phone: 707-565-2637